Multicultural counseling with the immigrant and refugee communities

“New word” is the empathic statement I find myself frequently using with my ninth-grade refugee group. As I attempt to explain what emotions are and as I ask each student how they are feeling today, I teach them a new word. That word being “mood.” When we discuss “stereotypes” and “bullying,” they are also learning these words along with the concepts. I receive looks of confusion when I encourage the students to partake in positive affirmation activities or activities to increase their “self-esteem” (another new word for many of these students).

These students continually challenge me. They question the relevance of counseling because mental health is not an aspect of their development that has been emphasized previously in any way. As a counselor trainee, I wondered how I could impact their psychological well-being when we faced a lingual barrier, a cultural barrier and time limitations each week.

As I have grown with the students throughout my internship, I have learned that there is universally power in their stories, both collectively and individually. Their shyness to share and to speak in group with their minimal English creates a soft, whispered effort to disclose issues and fears. As the facilitator, I use enthusiasm and a “thank you” to create a safe space where they may be empowered to speak. I suddenly realize that I am mimicking the works of their teachers, using the white board to spell feeling words so they can complete that session’s worksheets. I then tend to each dyad, explaining the group activity several times.

Unfortunately, my Gestalt, experiential techniques are typically tossed aside because group members feel more comfortable reading out loud what they wrote on worksheets. I have noticed that the members who are more proficient in English are better able and more likely to open up to the group. As we close the group, the idea to share their feelings or reflections of an activity may be limited to “Did you like the activity today?” These are just a few of the counseling techniques I have modified so these group members can experience the power of counseling.

In the afterschool program with immigrant and refugee students in middle school, the group members show interest in what I am about to present. They eagerly share the “Road Map of My Story” worksheet and the “Name Game” compliments they received. They clap after each person shares and cheer for their friends to take their turn rather than to pass. They, too, find comfort in the use of the white board, in having items written down before sharing and in learning new words each time I visit. These linguistic tools facilitate their connection to the program and to each other. Their experience is being shaped by these counseling terms; they have acquired novel methods of gaining and perceiving self-awareness in light of these newly learned concepts.

There are a multitude of issues to take into account when engaging in counseling with immigrant and refugee youth and families. Individual counseling with immigrants with limited English proficiency reveals that aspects of cognitive behavior therapy can be influential, but journaling in that person’s native language is preferred. Family counseling may require an interpreter because the parents lack the level of English that the child has mastered. Additionally, the technicalities of counseling are altered. For example, when working with adolescent immigrant youth, the child confirms or cancels appointments and makes decisions regarding mental health concerns more often than the parents. This can happen for a mixture of reasons but primarily is due to lingual hindrances for the parents.

Another focal area of counseling with this population is bicultural stress. This concept plays a role in every family interaction at diverse degrees and influences both parents’ and children’s understanding of the world and themselves. Although they may be open to receiving counseling, this population is embedded in more than one culture, and these cultures may have conflicting values. Parents often prefer that an authoritative counselor work with their child because, based on their viewpoint of counseling, that is culturally appropriate. Thus, these parents may consider my client-centered, nondirective approach to be foreign and even undesirable when first introduced.

In comparison with group work, individual counseling can allow for more disclosure and advancement in the counseling process for this population. This can be due to lingual issues or to the stigma that some cultures associate with mental health issues. Individual counseling with an unbiased stranger can provide immigrants and refugees the opportunity they need to question the norms of anxiety, depression and trauma-based memories. Countless times, clients from different cultures have shared with me the relief they gain upon learning how common or expected their issues are. As a counselor trainee, my professional development and approach in helping multicultural clientele has been heavily structured by these cultural experiences and realizations.

As an immigrant myself, I have intervened with the perspective of how I would have liked to have been helped by a counselor or other helping professional throughout my development as a bicultural student. I know that my struggles are unique and that my story holds value for me. I implement this outlook in my work with each group member or individual client. This is a form of empathy. This personal disclosure in my work creates an instant connection from one fellow immigrant to another.

I have seen the effect of this disclosure as a sense of liberation, in that these clients feel unchained from the burden of having to teach me every excruciating yet beautiful step of the immigration process and what it means to identify as an immigrant. I can use my understanding to build a space where we can examine a shared understanding of the emotional impacts of this process and where they can also feel personally and culturally validated through this awareness of their experiences on a broader communal level.

This is what motivated me to go into the field and to advocate for this population. This is the reason I am writing this article. For those counselors taking a multicultural approach who may not be immigrants, we all can benefit from the experiences of one another. By sharing our stories, we reciprocate to the counseling community.

Multicultural learning approaches must be mindful not to diminish the power of an individual’s journey. Academic understanding about collectivism, the ecological perspective and stressors involved in immigration are key elements, but they are not skills. Skills are built by interacting with these communities and adapting activities or therapeutic techniques to best serve clients. With this population, culture may or may not play an active role in how individuals make sense of their lives and experiences.

Regardless of whether culture plays a role, counselors cannot presume that clients will immediately be willing to share their experiences with them. Stories may be painful to share, or an individual may deem disclosure of such secrets unnecessary. Each client heals differently. Some have shown improvement in one session just by disclosure of a traumatic event, others simply by being surrounded by and receiving support from others who have endured similar pains. Then there are those who are healed purely by arriving in America — the place that is not home, but that has freed them from the turmoil in their countries of origin. There are a number of possible journeys in the healing processes of these clients, making experiential learning essential for counselors’ understanding of how to take an individualized care approach, while still taking culture into account.

Each of us immigrated for different reasons. Those original reasons may or may not reflect our lived experiences, but our identities are nonetheless largely rooted in the concept of being an immigrant or a refugee. Counseling can nurture this population through its open-ended nature. Counseling can one day be a worksheet on respect and self-care, and the next, an opportunity to share one’s fears and sadness about leaving home. Counseling is transformable and flexible. It has the strength to empower immigrants and refugees who in their cultures may not have been exposed to a helping service. It provides an opportunity to learn about and use indispensable tools for fostering growth and positive outcomes amidst the undeniable challenges faced.

Success stories include the quiet, young Nepali who finally spoke up in voicing stereotypes about this culture in group work, the older Mexican individual who continues to restructure negative thoughts to positive ones in a journal, and the immigrant dealing with an illness who now has the necessary resources to deal with its impacts. I have entered schools, community centers, churches and various agencies and conducted home visits because counseling allows me to travel. I do not need an office to help people. I need my counseling bag created in practicum and revised through internship to be an advocate, a counselor trainee, a fellow immigrant and, most significantly, a helping professional.

Among the lessons I have taken away from my experiences as an intern:

Resources are lacking for this population. A systems-of-care approach, which some clinics utilize, is advantageous for building resource capacity and a coordinated systems response to this population’s needs.

Refugees are easier to access because they typically are part of state-funded programs and may be placed in homogenous residential areas (for example, in apartments).

Counseling is often a foreign concept to many immigrants and refugees. Therefore, counselors seem to lack a serious role within these communities.

The value of emotional expression may not be a familiar or welcomed experience by some cultures. In fact, it may be viewed as unnecessary.

Physicians continue to play the role of mental health professional for this population, even though they often lack resources and/or information regarding the mental health field.

Schools and/or school-based programs are a highly effective avenue for counselors to become involved and play a role in the mental health of this population.

Do not be afraid to help those individuals who are learning English or whose accent is difficult to understand. They, too, can benefit from counseling. You can use an interpreter or refer out, but try to help in some way.

This population tends to deem components of narrative therapy and cognitive behavior therapy as helpful due to the processes of telling their stories and combating cognitive distortions.

Learn from these individuals who have stories to tell. You can help them find their voice with patience, encouragement and creativity.

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Shabnam Etemadi is a clinical mental health counseling student in the professional counseling program at Middle Tennessee State University. She will be graduating with her master’s degree later this month. Contact her at shabnam.etemadi@gmail.com or se2j@mtmail.mtsu.edu.

Dear Shabnam, I congradulate you on your success. Wishing you all the best in life today , tomorrow and always. You have wonderful ideas. I hope your way of counseling will benefit everybody in future.

Great article! My name is Cristina and I am a licensed clinician. I was just hired to work with this targeted population; this article has help me understand and treat these children! Good luck and success!
Best wishes,
Cristina Lopez-Scalzo, LMHC

Thank you for the article. I am an immigrant myself and a counselor. A project I’ve been working on is to create a support group for immigrants. This article has given me new ideas in terms of how to facilitate the group. I’m glad I run across this article today! Thank you for your insights and passion for this population.

Thank you for writing this inspiring article. I will be graduating this May 2015 and I am trying to decide which way to go. Your message has helped me re-route my career. I always wanted to work with this population but did not know how to start.
I A M in Gratitude for your words of wisdom!
<3Aura<3

Oh I am so glad to hear that you will be helping a population in such need of counseling intervention. Thank you for your courage to advocate and to help this group. I am moved to learn I had any influence on this wonderful career move. Best of luck to you & please reach out should you need help in the future.

Thank you for putting your experience in writing for all to read and benefit from. I can relate to some of the experience you talked about, being in the helping profession myself. I wish you all the best and do continue to make a difference.

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